Dental Claims Specialist Job at Beacon Hill (St. Louis)

Dental Claims Specialist

Location

United States , St. Louis

Salary:

21.00 USD / Hour

Beacon Hill

Expiration Date

Until further notice

Requirements

Recent Dental experience is a must have
Health Plan experience is strongly preferred
Familiar with CDT codes and dental terminology
Coordination of Benefits a huge plus
Ability to operate at a fast pace
Strong attention to detail
Must be local to St. Louis, MO

Fulltime

Dental Claims Specialist

Location

United States , St. Louis

Salary:

21.00 USD / Hour

Beacon Hill

Expiration Date

Until further notice

Requirements

Recent Dental experience is a must have
Health Plan experience is strongly preferred
Familiar with CDT codes and dental terminology
Coordination of Benefits a huge plus
Ability to operate at a fast pace
Strong attention to detail
Must be able to work a hybrid schedule

Fulltime

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN OR Dental Hygienist
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
Prepare cases for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN OR Dental Hygienist
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
Prepare cases for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN OR Dental Hygienist
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
Prepare cases for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN OR Dental Hygienist
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
Prepare cases for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

New

Senior Manager, Global Benefits

PerkinElmer is seeking an experienced Global Benefits Manager to join our Total ...

Location

United States , Remote

Salary:

132500.00 - 150000.00 USD / Year

PerkinElmer

Expiration Date

Until further notice

Requirements

Bachelor’s degree in business, finance, human resources, or a related field
10+ years of progressive benefits experience, with significant depth in US self-insured health plan design, administration, and strategy
2+ years of global benefits administration and familiarity with global pooling
CEBS (Certified Employee Benefit Specialist) or CBP (Certified Benefits Professional) designation preferred
Demonstrated experience managing consultant relationships and holding external partners accountable for performance and value delivery
Strong command of US benefits regulatory compliance, including ERISA, ACA, HIPAA, COBRA, FMLA, and related requirements
Experience managing open enrollment end-to-end, including testing and communications
Analytically strong — able to work with claims data, cost trend analysis, and financial modeling
comfortable presenting to senior leadership

Job Responsibility

Serve as primary owner of the US self-insured medical, prescription drug benefit and dental programs, with deep understanding of plan funding, claims administration, and stop-loss structure
Partner with the US consultant (WTW) and third-party administrators to manage plan performance, cost trends, and utilization, bringing forward proactive, creative recommendations to reduce trend
Own and manage relationships with all US benefits vendors including medical, dental, vision, life, disability, EAP and voluntary
Lead annual plan design review and renewal strategy in close partnership with WTW
Own the annual open enrollment process end-to-end
Develop and execute a communications strategy that is employee-centered
Create and maintain employee-facing benefit resources including guides, orientation, FAQs and change communications
Partner with HR Technology and benefits administration vendor to ensure accurate plan configuration
Act as the escalation point for complex employee benefits issues and appeals
Ensure plan documents, SPDs, and legal notices are accurate, current, and compliant

Fulltime

Medical Accounts Receivable Specialist

This contract-to-permanent position involves managing the full insurance revenue...

Location

United States , Bellevue

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 3 years of experience in healthcare, dental, or medical insurance accounts receivable and revenue cycle management
Proficiency in handling accounts receivable, cash applications, and billing functions
Solid understanding of health care revenue cycle processes, including collections and cash activity
Strong analytical skills to identify issues and implement solutions for claim denials and payment discrepancies
Familiarity with payor-specific regulations and contractual requirements
Ability to manage provider credentialing and enrollment processes efficiently
Excellent communication and collaboration skills to work effectively across teams and departments
Strong attention to detail and organizational skills to maintain compliance and ensure accuracy in all tasks

Job Responsibility

Oversee insurance accounts receivable processes from initial charge posting to final resolution
Investigate and resolve unpaid, underpaid, or denied claims promptly and accurately
Ensure claims meet payor guidelines and adhere to clean-claim standards to prevent revenue loss
Post payments and adjustments with precision and reconcile explanation of benefits to maintain accuracy
Monitor credentialing timelines for providers, ensuring timely enrollment and re-credentialing with contracted payors
Identify and address root causes of claim denials, implementing corrective measures to mitigate recurring issues
Maintain compliance with state regulations, payor contracts, and internal revenue integrity standards
Track and report key revenue cycle metrics, such as denial rates, days in accounts receivable, and net collection ratios
Collaborate with operations leadership and care center teams to resolve reimbursement issues and streamline processes
Serve as the primary liaison for credentialing matters, audits, and compliance reviews related to provider enrollment

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Dental Claims Specialist

Beacon Hill

Location:
United States , St. Louis

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 22, 2026

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